Social Phobia

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Social phobia (SP) is defined as an intense, irrational, and persistent fear of being scrutinised or evaluated by others, with the patient anticipating humiliation or ridicule. Most social interactions/situations where one may be judged or confronted with specific public performance may trigger the fear. Anticipation of these situations is accompanied by feelings of uneasiness, distress, or fear.

SP has a chronic, unrelenting lifelong course, and secondary complications such as depression, substance abuse (alcohol or tranquillizers), and suicide attempts may occur, making the disorder severely disabling. SP is becoming known as one of the more common anxiety disorders.

Individuals with SP are frequently hypersensitive to criticism, fear negative evaluation, have increased perceptions of rejection, difficulty asserting themselves, and have low self-esteem or feelings of inferiority. Individuals suffering from social phobia may find it difficult to take tests because they are afraid of being judged indirectly by others. Individuals with this disorder frequently exhibit observable signs of anxiety (poor eye contact, making sounds like "uh" and "um" during speech). Attending school or working may also be difficult for people who are socially anxious, and they tend to underachieve in these areas.

Comorbidity among people with SP is extremely high, exceeding 80% in clinical settings. Major depression, dysthymia, panic disorder, GAD, specific phobias, and alcohol use disorders are the most commonly diagnosed comorbids in adults. Oppositional defiant disorder, conduct disorder, and ADHD are all prevalent in children.

Avoidant Personality Disorder (AVPD), which involves severe restriction and avoidance of situations in which one feels judged, has a high overlap with SP, with over 40% of people with SP also meeting AVPD criteria. It is more severe than SP in general, and some researchers believe it is simply an extreme variant of SP. However, other research indicates that there are several differences between the two, and that it may be more related to schizophrenia spectrum disorders.

SP is the anxiety disorder with the highest percentage of cases beginning in childhood, with reliable and valid cases seen as young as six years old. Children are more likely to exhibit symptoms such as crying or tantrums, freezing up, and clinging to a familiar person. They may also exhibit inhibited social interactions, even to the point of selective mutism, and may appear extremely timid and uninterested in group activities. Children, like college-aged adults, demonstrate signs of underachievement in school when compared to their academic and intellectual potential. Unlike adults, many children may be unable to identify the source of their anxiety and are frequently unable to avoid feared situations because they are coerced into them by adults.


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Over half of adults self-report having problems as a child, and nearly 80% report developing the disorder by the age of 20. Lower-level, non-clinical SP is common, with one study finding that 20% of participants reported excessive fear of public speaking and performance, but only about 2% appeared to experience enough impairment or distress to warrant an SP diagnosis. In the general population, most people with SP are afraid of public speaking, but only about half are afraid of speaking to strangers or meeting new people.

In the U.S., higher rates of SP are seen among those of lower socioeconomic status, as well as persons with lower levels of education. While Native Americans are at a higher risk than Caucasians for development of SP, other minority groups show lower rates. Interestingly, people living in urban areas in both the U.S. and abroad show lower levels of SP.

Cross-country comparisons show much higher rates in the U.S. (7.1% for 1-year rates) compared to non-Western nations, such as Japan (0.8%), South Korea (0.2%), urban China (0.2%), Mexico (1.7%), South Africa (1.9%). Even compared to Europe (1.1-2.3%) and Australia (1.3%), U.S. rates are much higher.

When Western and Asian populations are compared, there appears to be a clear distinction between what causes social anxiety: fear of embarrassing oneself (Western) versus fear of offending others (Eastern). What the individual fears they will do or present, such as having an unpleasant body odour or staring at another person's crotch or chest, distinguishes them from most cases of SP.

Reference:

Faravelli, C., Zucchi, T., Perone, A., R. Salmoria, & Viviani, B. (2003). Social Phobia. 137–155. https://doi.org/10.1002/0470846437.ch7 ‌6.104: Social Phobia. (2020, July 23). Social Sci LibreTexts. https://socialsci.libretexts.org/Courses/Lumen_Learning/Book%3A_Abnormal_Psychology_(Lumen)/06%3A_Case_Studies_of_Fictional_Characters/6.104%3A_Social_Phobia#:~:text=Also%20known%20as%20Social%20Anxiety,esteem%20or%20feelings%20of%20inferiority.

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